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Burnett County Office of Zoning Administrator C - 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < as <br /> rnett <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the BuCounty Land Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> s....... . ...........:. ................ .. ................. ..........................ivr.....t-................................................. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> a :kms <br /> ...(A..... .............. 'a <br /> it <br /> ADDRESS ADDRESS pC i i� <br /> ADD-R�ESS 777 t� ADDRESS � <br /> ........(. ..`:?...::?4.. ..-.. ...1. '',��........................................ ............................................................................................ <br /> PHONE PHONE <br /> ................ ... !( I�%.G.... .............................................. ................ .... : .1.!.4.... ............................................... i <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... .......DRES.......S.............................................................................. <br /> ADDRESS ADm 0) <br /> n o <br /> PHONE PHONE Z � r <br /> DESCRIPTION 4. Sanitary Facilities: ° g o •r <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •"'�"' : <br /> o f <br /> New Building .,,,X, Type of Construction: No. Bedrooms ... ... <br /> Septic Tank Size Gals. .......... ` D <br /> Addition .......... ....k+�S,it'..Q......... . <br /> . ...................... <br /> Sanitary .......... Size .....1.7— ft. x ..... ft. .......... i <br /> Filling/Grading .......... Height...1.7.... Stories ....../........ 4a. Absorption Field Site: i <br /> Moving Area .......3k: <br /> Soil Type ..................0 :rl. ..... ...... ............ <br /> Mobile Home ,,.... Slope ......................... . ........... <br /> i <br /> Privy , 3. Use (describe exactly, 1 family <br /> Perc. Rate ................................... <br /> Well home, .m...o.t,el., e.tc.)... ., .... Dr <br /> Well <br /> .......... <br /> Subdivision Seepage Trench ...... <br /> ,,,,,,,,,, <br /> Camping Unit .......... Privy .. <br /> ...................................4................ <br /> 3� <br /> ii <br /> Seepage Bed ......... <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched In Fig. A. Include road ( � <br /> or <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- o- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 1 !� p <br /> ---------------------------------------------------------------------- <br /> i? <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x ..._......... ft. — ..................... ......... sq. ft. ............................................................................... �) i <br /> N O <br /> O� <br /> iN <br /> vl <br /> ��� %� � •sir t� � <br /> :_ <br /> E>J <br /> z E <br /> f_ o <br /> n <br /> G Prrvr Mto r v m m z <br /> n c� < - c m <br /> _ F <br /> '•• t�Ci CB ro SI(Je `0 en a C " m m <br /> O VI < •� c m <br /> PY� � o �. m Dam <br /> � •ti w t1 z o Lr n e z CD n � 70 <br /> I C' o � = 22 ii, g <br /> �C'Jk � <br /> XAA_...... .. ... . �".1. ' Q .5�.. m <br /> Sig /J O n \ Date ` C <br /> Remarks .......... //vSic�C'.....!.i.:......^.. ,5,$.u.:: ....��`ir'1.../I!!..f�!!::4.�G1ln�t I " x 0 <br /> \\ V1"/T ..................... <br /> ............................................................................................................ . ............<......................................................... <br /> T <br /> Inspection Date ....................................... .. . ....... ' : 8 <br /> ........... . . . . . .......... .I <br /> Zon'ng Administrator :J 8 8 8 8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facilitic. <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked If misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />